ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2022
Geographic disparities in lung transplantation in the United States before and after the November 2017 allocation change.
Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Inconsistent values and algorithmic fairness: a review of organ allocation priority systems in the United States.BMC medical ethics · 2024Pooled it
- Impact of lung allocation policy reforms on center volume redistribution and survival after lung transplantation.JHLT open · 2026Article
- Current opinion in pediatrics: pediatric lung transplantation in the 21 st century.Current opinion in pediatrics · 2026Review
- Waiting List Survival Trends in Pediatric Lung Transplantation: A National Cohort Study.Pediatric pulmonology · 2026Article
- An early nationwide analysis on the continuous distribution of lung-involved multiorgan transplantation.JTCVS open · 2026Article
- Association Between Distance to the Transplant Center and Survival Following Living Donor Liver Transplantation.Annals of gastroenterological surgery · 2025Article
- Health disparities and associated social determinants of health in interstitial lung disease: a narrative review.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Identifying inequities in lung transplantation: a call for strategies and future research.JHLT open · 2023Article
- Lung transplant waitlist outcomes among ABO blood groups vary based on disease severity.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2023Article
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14 authors.
Funding
Abstract
backgroundThe primary lung allocation unit was expanded from the donation service area to a 250-mile radius in 2017. Prior to the change, geographic disparities in donor lung availability impacted waitlist outcomes. We sought to determine if the new allocation system improved these disparities.
methodsWe conducted a retrospective cohort study comparing the 2-year period before and after the change. Donor lung availability was defined as the ratio of donor lungs to waitlist candidates in the primary allocation unit. Transplant centers were divided into quartiles by donor lung availability. Multivariable competing risk models were used to determine the association between lung availability and waitlist outcomes. Multivariable Cox proportional hazards models compared post-transplant survival.
resultsPrior to the allocation change, the unadjusted transplant rate at centers in the lowest and highest quartiles was 132 and 607 transplants per 100 waitlist years. Candidates in the lowest quartile of donor lung availability had a 61% adjusted lower transplantation rate compared to candidates in highest quartile (sub-hazard ratio [sHR]: 0.39, 95% confidence interval [CI]: 0.34-0.44). After the allocation change, the disparity decreased resulting in an unadjusted transplant rate of 141 and 309 among centers in the lowest and highest quartiles. Candidates in the lowest quartile had a 38% adjusted lower transplantation rate compared to those in the highest (sHR: 0.62, 95% CI: 0.57-0.68). There was no significant difference in 1-year post-transplant survival.
conclusionsAlthough the expansion of the primary allocation unit improved disparities in waitlist outcomes without any change in post-transplant survival, there still remain significant differences due to geography.
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